EDITORIALS

LePage subverts Legislature’s push to prevent smoking

Posted Jan. 23, 2014, at 1:32 p.m.
Gov. Paul LePage speaks to a packed auditorium at John Bapst Memorial High School on Dec. 6, 2013.
Kevin Bennett
Gov. Paul LePage speaks to a packed auditorium at John Bapst Memorial High School on Dec. 6, 2013. Buy Photo

The Maine Legislature took a couple strong votes recently to require MaineCare to cover the costs of smoking cessation treatments. On Tuesday the Maine Senate overwhelmingly reversed Gov. Paul LePage’s veto of LD 386, voting 31-4; on Jan. 16 the House did the same, voting 131-10 to override. It’s unusual to see such bipartisan opposition to the governor’s priorities, and in this case it was definitely warranted.

We are pleased with the bill and glad to see bipartisan backbone. Republicans and Democrats in the Legislature have been trying for awhile to correct the mistake made by the LePage administration in 2012 when it canceled MaineCare coverage of smoking cessation products.

But while they did the right thing, they could only achieve a partial victory. That’s because LePage waited so long to veto the bill — using what’s called a pocket veto — that the bill lost much of its purpose.

Why? Because covering smoking cessation products is now required by federal law.

The bill sponsored by Rep. Linda Sanborn, D-Gorham, outlines the specifics of how Maine will provide coverage, but the Affordable Care Act required all state Medicaid programs to cover tobacco cessation medications starting Jan. 1.

Sanborn’s bill would have provided MaineCare recipients’ coverage for smoking cessation products up until Jan. 1, but LePage prevented that from happening. He remained opposed even though the Legislature voted nearly unanimously back in June (with only one “no” vote) to pay for the services.

The Legislature still had to prepare for the federal requirement, however, so it allocated funding for MaineCare coverage of smoking cessation medications in the budget also approved last June. LD 386 provides direction for how those funds are spent and additional funding through the Fund for a Healthy Maine — but not as much as it would have if it had passed the governor’s desk last spring.

We are disappointed by the whole ordeal — and that coverage for preventive care continues to be a problem for LePage. Maine residents should expect more from their governor than a continued fight over something so basic.

The reasons for requiring MaineCare to cover smoking cessation products are obvious: Tobacco use is the leading cause of preventable death in Maine; many superb studies explain how to stop these needless deaths and treat tobacco addiction; and pharmaceutical options and counseling are some of the best ways to do so.

Those enrolled in MaineCare arguably need the cessation coverage the most: 42 percent smoke, compared with 17 percent of non-MaineCare recipients. Study after study shows that in the long-term, it’s cheaper to pay for prevention than treatment.

Direct health care costs attributed to smoking and paid by MaineCare total $216 million per year, according to a 2008 report. The percentage spent on prevention is small.

Maine set aside $550,000 in state general funds to provide MaineCare coverage for cessation during the two-year budget cycle that started July 1, 2013, which means it can draw down at least $880,429 in federal funding.

Because of the bill finally approved Tuesday, it can also use $14,014 next fiscal year from the Fund for a Healthy Maine, which collects and disburses the state’s settlement payments from lawsuits against tobacco companies. The money will make $22,433 in federal funds available.

The governor stated in his veto letter that MaineCare recipients should have to share the costs of their smoking cessation treatment. While this seems to make sense, the science shows that if states want as many people as possible to use a service they otherwise wouldn’t, they should reduce the barriers to that service as much as possible. Maine stands to gain more from preventing disease and death.

The U.S. Centers for Disease Control and Prevention outlines many ways for states to incentivize people to stop smoking, including reducing out-of-pocket costs for patients. In fact, it would recommend Maine spend more on state and local smoking intervention programs, suggesting $18.5 million annually.

Maine appears to be getting back on track when it comes to stopping smoking-related illnesses before they become heartbreaking and more costly. But, as with most prevention initiatives, success depends on comprehensive approaches used consistently — across decades. It also depends on leadership being able to steer that course.

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